Antimicrobial Resistance in Bacterial Isolates from Patients Attending a Cancer Center

Abstract

Background: Bacterial infections are the most frequent complications in patients with malignancy, and the epidemiology of nosocomial infections among cancer patients has changed over time. There is increasing evidence from different parts of the world with high percentage of antimicrobial-resistant bacterial isolates in cancer patients. This study aimed to characterize the antimicrobial resistance in the bacteria isolated from clinical specimens from the cancer patients.
Methods: A hospital-laboratory-based, cross-sectional study was conducted on the bacteria isolated from the patients taking medical services at Nepal Cancer Hospital and Research Center (NCHRC), Lalitpur, during June 2023 to May 2024. All the clinical specimens received at the Department of Pathology and Laboratory Medicine, from patients admitted in the wards and OPD of the hospital were processed following standard guideline and protocol for isolation, phenotypic identification and antibiotic susceptibility testing.
Results: Out of the 4273 samples processed, bacterial growth was observed in 23% (987) of the samples with 1016 bacterial isolates. The most common isolates were E. coli 36% (364), Klebsiella pneumoniae 24 % (241), Pseudomonas aeruginosa 14% (144) and Citrobacter freundii 8% (78). Bacterial infection was significantly associated with age, gender, fever and prior antibiotic use. Antimicrobial susceptibility testing clearly showed that Gram-negative bacterial isolates were highly resistant to Amoxycillin-clavulanate (66.7% to 100%), Nitrofurantoin (60% to 100%) and least resistant to Amikacin (28% to 50%).Gram-positive were found to be resistant to Amoxycillin-clavulanate (36.8% to100), Ciprofloxacin (35.3% to 68.6%) and least resistant to Vancomycin (14.3% to 17.6%). Multidrug resistance was observed in 68% of the gram-negative and 46.5% in gram-positive bacterial isolates
Conclusions: The result clearly indicates the need for local antibiotic resistance/susceptibility dashboard, updated periodically for aligning the local treatment protocols for the hospital, which could help to rationalize the antimicrobial prescription, leading to better patient outcome in terms of morbidity and mortality in highly vulnerable group, like cancer patients.
Keywords: Antimicrobial resistance; bacterial infection; cancer; multi-drug resistance.